Sánchez-Román Sofia, Chavarri-Guerra Yanin, Vargas-Huicochea Ingrid, Alvarez Del Río Asunción, Bernal Pérez Pilar, Morales Alfaro Andrea, Ramirez Maza Daniela, de la O Murillo Andrea, Flores-Estrada Diana, Arrieta Oscar, Soto-Perez-de-Celis Enrique
Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Departamento de Hemato-Oncología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
JCO Glob Oncol. 2022 Mar;8:e2100324. doi: 10.1200/GO.21.00324.
The financial toxicity (FT) of cancer is common among older adults in high-income countries, but little is known about the financial hardships faced by older patients with cancer living in developing countries. The aim of this study was to explore the financial burden of cancer among older Mexican adults and their relatives, as well as factors that might mitigate such burden.
This mixed-methods study included patients age 65 years and older with the 10 most common malignancies in Mexico and 3-24 months from diagnosis at two cancer centers in Mexico City and their relatives. For the quantitative component, patients and relatives answered the Spanish version of the Consumer Financial Protection Bureau Financial Well-Being Scale. Patients completed the Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) scale and a 3-month, self-reported cost diary. For the qualitative component, focused interviews were used to explore the individual experiences of patients and their relatives.
Ninety-six patients and their relatives were included, of whom 45% had stage IV disease. On the COST-FACIT scale, 9% reported no FT, 52% mild FT, 39% moderate FT, and 0% severe FT. The mean Consumer Financial Protection Bureau Financial Well-Being Scale score was 45.2, with 78% reporting poor financial well-being (score ≤ 50). On cost diaries, most expenses were associated with purchasing medications, including chemotherapy. Focused interviews showed that most patients and relatives had to acquire debt to face costs of cancer care.
A high proportion of Mexican older adults with cancer reported FT and poor financial well-being. Understanding experiences associated with FT and strategies to mitigate it represents an essential first step to design public policies aimed at protecting older adults with cancer and their families from catastrophic spending.
癌症的经济毒性（FT）在高收入国家的老年人中很常见，但对于生活在发展中国家的老年癌症患者所面临的经济困难却知之甚少。本研究的目的是探讨墨西哥老年成年人及其亲属患癌症的经济负担，以及可能减轻这种负担的因素。
这项混合方法研究纳入了年龄在65岁及以上、患有墨西哥10种最常见恶性肿瘤且在墨西哥城的两个癌症中心确诊后3至24个月的患者及其亲属。对于定量部分，患者和亲属回答了消费者金融保护局金融福祉量表的西班牙语版本。患者完成了金融毒性综合评分-慢性病治疗功能评估（COST-FACIT）量表和一份为期3个月的自我报告费用日记。对于定性部分，采用聚焦访谈来探讨患者及其亲属的个人经历。
纳入了96名患者及其亲属，其中45%患有IV期疾病。在COST-FACIT量表上，9%报告无经济毒性，52%报告轻度经济毒性，39%报告中度经济毒性，0%报告重度经济毒性。消费者金融保护局金融福祉量表的平均得分是45.2，78%报告金融福祉较差（得分≤50）。在费用日记中，大多数费用与购买药物有关，包括化疗药物。聚焦访谈显示，大多数患者和亲属不得不举债来支付癌症治疗费用。
很大一部分患有癌症的墨西哥老年人报告了经济毒性和较差的金融福祉。了解与经济毒性相关的经历以及减轻经济毒性的策略是设计旨在保护患有癌症的老年人及其家庭免受灾难性支出影响的公共政策的重要第一步。
